Renal Pelvis, Ureter, Urethra Cancers

21.03.2024

DIAGNOSIS AND TREATMENT OF RENAL PELVIS, URETER AND URETHRA CANCERS

Pelvic ureteral urethra cancer is a rare type of cancer that affects the ureters, urethra, and tissues in the pelvic area. This cancer occurs as a result of abnormal growth and proliferation of cells in the urinary tract. Although pelvic ureter urethra cancer is rare, it is a serious health problem because these areas are connected to the body's urinary excretion system. Early diagnosis, treatment and follow-up are important because when cancer progresses, it can have negative effects on the functionality of the urinary tract and overall health. Treatment options may include surgery, radiotherapy, chemotherapy or immunotherapy, depending on the stage and extent of spread of the cancer. Treatment for pelvic ureteral urethral cancer is individualized according to the patient's health status and the characteristics of the cancer and may require a multidisciplinary approach. Early diagnosis and appropriate treatment can increase patients' chances of survival.

WHAT ARE THE RISK FACTORS?

Pelvic ureter urethra cancer risk factors may include:

Age: This type of cancer usually occurs at older ages. Advanced age may increase the risk.

Gender: This type of cancer is more common in men than in women.

Smoking: Smoking may increase the risk of urinary tract cancers, so smokers may have a higher risk.

Medicines: Long-term use of certain medications (e.g., phenacetin) may increase the risk of pelvic ureteral cancer.

Chemical Exposure: Long-term exposure to chemicals may increase the risk of this type of cancer. In particular, some industrial chemicals may increase this risk.

Family History: The risk may be higher in people with a family history of urinary tract cancers.

Chronic Inflammation: Chronic inflammatory conditions (for example, urinary tract infections) may increase the risk of pelvic ureteral cancer.

Radiation Exposure: The risk may be increased in people who have been exposed to radiation in the past.

Medicines: Certain medications may increase the risk of pelvic ureter urethra cancer.

Risk factors may vary on an individual basis, and there may be more than one factor that affects a person's likelihood of developing this type of cancer. Therefore, it is important to consult with a healthcare professional to evaluate risk factors and your personal risk.

Image 1: Renal pelvis, ureter and urethra cancers are rare compared to other cancers.

HOW DOES IT OCCUR?

Although the development mechanisms of pelvic ureter and urethra cancer are not yet fully understood, there are some possible factors. It is thought that genetic factors, environmental factors and personal risk factors may be effective in the formation of this cancer. In particular, genetic mutations or genetic predisposition can trigger cancer development by causing DNA damage and cells losing control of normal growth and division. Environmental and lifestyle factors such as smoking, chemical exposure, radiation exposure, and long-term urinary tract infections may also increase risk. The development of pelvic ureteral urethral cancer is a complex process and more research is needed, but the interaction of these factors may play a role in the development of the disease.

WHAT ARE THE SYMPTOMS?

Symptoms of pelvic ureter urethra cancer may include:

Urinary Tract Symptoms: The most common symptoms of pelvic ureter urethra cancer are urinary tract symptoms. These symptoms may include frequent urination, pain or burning sensation when urinating, changes in urine color (bloody or cloudy urine), difficulty urinating, and poor urine flow.

Backache: The growth or spread of cancer in the pelvic area can cause lower abdominal or lower back pain.

Urinary Tract Obstruction: The flow of urine may be blocked due to urinary tract obstruction as a result of the tumor blocking the ureters or urethra.

Urinary Incontinence: If the tumor affects the urinary tract, it may cause urinary incontinence problems.

Weight Loss and Fatigue: In advanced cancer cases, weight loss and fatigue may occur as a result of the cancer affecting the metabolism.

These symptoms may vary from person to person, and symptoms of pelvic ureter urethra cancer may also be related to other health problems. Therefore, a person who experiences such symptoms should consult a healthcare professional and have the necessary examinations and evaluations performed. Early diagnosis can help treat cancer effectively.

HOW IS IT DIAGNOSED?

Diagnosis of pelvic ureter and urethra cancer is usually made using a series of medical tests and imaging methods. The first step is a detailed evaluation of the patient's symptoms and medical history. A physical examination is then performed and a urinalysis is used to rule out urinary tract infections or other urinary tract problems. Tests that play an important role in diagnosis include imaging studies such as computed tomography (CT) or magnetic resonance imaging (MRI). These imaging methods help evaluate the location, size, and extent of spread of the tumor. It is also often necessary to directly observe and biopsy the tumor through a procedure called cystoscopy. A definitive diagnosis is made based on biopsy results and the type, stage and treatment options of the cancer are determined. The diagnostic process is guided by a urologist or oncologist and planned specifically for the patient's health status and symptoms.

WHAT ARE THE PATHOLOGICAL TYPES?

Pathological types of cancer of the pelvis, ureter and urethra can be:

Ürotelyal Karsinom: It is the most common pathological type of pelvis, ureter and urethra cancer. This type of cancer originates from the inner surface cells of the urinary tract and begins in tissue called the urothelium.

Squamous Cell Carcinoma: This type of cancer arises from squamous cells and is less common. It usually originates from the squamous cells of the urethra.

Adenocarcinoma: Adenocarcinoma arises from glandular cells and is a rarer pathological type.

It should be noted that each pathological type may differ in terms of treatment and prognosis. The diagnosis is made based on the results of biopsy and histopathological examination and it is determined which pathological type it belongs to. The receptors that need to be examined in pelvis, ureter and urethra cancer are of great importance to understand the biological characteristics of the disease and the response to treatment. These receptors help personalize patients' treatment plans. PD-L1 (Programmed Death Ligand 1) and PD-1 (Programmed Death 1) receptors are important for assessing response to immunotherapy and determining the ability of the patient's immune system to fight cancer. Careful monitoring and analysis of these receptors allows patients to receive more effective and personalized cancer treatment.

Image 2: Ureteroscopy can be performed to diagnose renal pelvis, ureter and urethra cancers.

HOW IS TUMOR STAGING DONE?

Pelvis, ureter and urethra cancer staging is a system used to determine the extent and location of cancer spread. This staging is important to evaluate how far the cancer has progressed and to determine appropriate treatment options. The TNM system (Tumor, Node, Metastasis) used by the American Cancer Society is a frequently used system for staging pelvis, ureter and urethra cancer. This system includes the following elements:

T (Tumor):This section describes the size of the tumor and what organs or tissues it has spread to. T usually has a rating between 0 and 4, with 0 representing the earliest stage and 4 representing the most advanced stage.

N (Lymph Nodes): This part indicates whether the cancer has spread to surrounding lymph nodes. N usually has a rating between 0 and 3.

M (Metastasis): This section indicates that the cancer has spread to distant organs or tissues. M is usually evaluated as 0 (unspanned) or 1 (spread).

Based on these TNM staging results, the cancer is graded from stage 0 to IV. Staging results help the patient plan treatment based on the extent of cancer spread. In particular, early-stage cancers are often treated more successfully, while advanced-stage cancers may require more complex and aggressive treatment. Therefore, staging of pelvis, ureter and urethra cancer should be carefully done and evaluated by the patient's healthcare team.

HOW IS TREATMENT DONE ACCORDING TO STAGES?

Treatment for pelvic, ureteral, and urethra cancer may vary depending on the stage of the cancer and other factors. According to the staging results, treatment approaches may be as follows:

Stage 0: If the cancer is only limited to the superficial layer, it may be necessary to remove the tumor, usually by surgical intervention or endoscopic methods, and monitor it closely.

Stage I and II: If the cancer has spread to deeper tissues, surgery is often the primary treatment option. This surgical procedure involves removing the tumor and aims to preserve surrounding healthy tissues. Lymph nodes may also be examined or removed. Radiotherapy or chemotherapy after surgery may sometimes be considered as additional treatment.

Stages III and IV: If the cancer is in more advanced stages, treatment options may become more complex. In these stages, radiotherapy and/or chemotherapy can generally be used in addition to surgical intervention. Chemotherapy can help control the spread of cancer or reduce the size of the tumor. Immunotherapy and targeted therapies may also be in the research process in advanced stage cancers.

Each patient's situation is different, and the treatment plan is personalized based on the patient's age, general health, and the biological characteristics and stage of the tumor. To determine and administer treatment, a multidisciplinary healthcare team works together to provide cancer patients with the best outcomes. Therefore, it is important for patients diagnosed with pelvic, ureteral, and urethral cancer to collaborate closely with a urologist or oncologist.

Image 3: If urine flow slows down due to renal pelvis, ureter and urethra cancers, a nephrostomy catheter can be inserted temporarily or permanently.

WHAT ARE THE DRUGS USED IN TREATMENT?

Treatment methods used in pelvis, ureter and urethra cancer may vary depending on the stage and type of cancer. Some treatment options used in these types of cancer:

Chemotherapy: Platinum-based chemotherapy is used to kill or stop the growth of cancer cells. It can be used especially in stage III and IV cancers and cancers that have spread.

Targeted Drugs: Drugs that are effective against specifically targeted genetic or molecular characteristics of cancer cells are used. These drugs target cancer cells and cause less damage to healthy cells.

Immunotherapy-Checkpoint Inhibitors: Immunotherapy is used to stimulate the immune system to attack cancer cells. Checkpoint inhibitors that block the activation of immune cells, such as PD-1 or PD-L1, may make it easier for cancer cells to be recognized by the immune system.

These treatment options are determined by doctors depending on the patient's stage, tumor biology, and general health condition. The treatment plan is shared with the patient and can be adjusted according to the patient's response to treatment. Cancer treatment requires a multidisciplinary approach and is guided by a team of physicians.

HOW SHOULD FOLLOW-UP BE DONE AFTER RECOVERY?

It is very important to follow up pelvis, ureter and urethra cancer patients after recovery. Post-treatment follow-up is done to detect the return of cancer or possible complications early. This follow-up usually includes: regular doctor exams, imaging tests (for example, CT or MRI scans), urine tests, and blood tests. While cancer recurrence or metastases are monitored during follow-up, possible side effects of the treatment are also taken into account. Follow-up is important to closely monitor the patient's health and adjust treatment as necessary. Every patient is different, so the follow-up plan is personalized based on the patient's specific condition and response to treatment. Suitable follow-up helps patients best navigate the process of coping with cancer and allows physicians to support patients.